Acute muscular sarcocystosis: an international investigation among ill travelers returning from tioman island, malaysia, 2011-2012.

BACKGROUND Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. METHODS Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. RESULTS Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. CONCLUSIONS Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.

Norm and Anomaly in the Jewish Life of Jesus (Toledot Yeshu)

The Toledoth Yeshu, the “Generation,” or “Life of Jesus,” have been described as an anti-Gospel, or a parody of the Gospel. This protean tradition, witnessed in more than hundred manuscripts and printed editions, offers a “counter-history” of the life of Jesus and the origins of Christianity. According to this mischievous narrative Jesus was an illegitimate child turned charlatan, and his disciples a bunch of violent and senseless rogues who continued to stir up trouble in Israel even following their leader’s shameful hanging. The Toledoth Yeshu is the story of an anomaly (Jesus and the birth of Christianity). It is also a story about confusion: marital confusion, social confusion, and religious confusion. As an exercise in “historical imagination,” the Toledoth Yeshu offers a narrative of religions compared, and a reflection on social and religious borders, on their instability and fragility, and ultimately on their necessity. The present paper will explore the normative dimension of the Toledoth Yeshu tradition: the way the “disorder of things” the narrative relates also conveys a powerful discourse on social and religious norms. We will also seek to map this tradition in the broader context of medieval Jewish discussions on Jesus (particularly Maimonides) as a “case” in the religious history of mankind, addressing issues of false prophecy, religious deviation, transgression, and heresy.